Provider Demographics
NPI:1558572339
Name:COFFEY-LUMPKIN, ANGIE A (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:A
Last Name:COFFEY-LUMPKIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 N COUNTY ROAD 21 W
Mailing Address - Street 2:
Mailing Address - City:LIZTON
Mailing Address - State:IN
Mailing Address - Zip Code:46149-9458
Mailing Address - Country:US
Mailing Address - Phone:317-209-2332
Mailing Address - Fax:317-273-1444
Practice Address - Street 1:8616 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-2167
Practice Address - Country:US
Practice Address - Phone:317-209-2332
Practice Address - Fax:317-273-1444
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000298225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist